A physical disability does not automatically end driving. Hand controls, left-foot accelerators, spinner knobs, wheelchair lifts and reduced-effort steering let many people with spinal cord injuries, amputations, stroke or multiple sclerosis keep their licence. The path usually starts with a professional driver evaluation.
The driver rehabilitation evaluation
A certified driver rehabilitation specialist, often an occupational therapist with additional training, carries out the evaluation. The clinical part tests vision, reaction time, strength, range of motion and cognition. The on-road part uses a vehicle fitted with adaptive equipment and dual brakes. The result is a written report that recommends specific equipment, training hours and any licence restrictions. In the United States the Association for Driver Rehabilitation Specialists (ADED) keeps a directory of certified evaluators; many rehabilitation hospitals run their own programmes.
Common modifications
Hand controls that push for brake and pull or twist for accelerator are the most frequent modification and cost a few thousand dollars installed. Left-foot accelerators help people who have lost use of the right leg. Wheelchair-accessible vans with ramps or lifts, transfer seats and lowered floors range widely in price. High-tech systems for people with limited upper-body strength use joysticks or voice input and require extensive training. Equipment must be installed by a dealer accredited by the National Mobility Equipment Dealers Association (NMEDA) if it is to be recognised by insurers and funders.
Who pays
Funding in the US comes from several directions: state vocational rehabilitation agencies if driving is needed for work, the Department of Veterans Affairs for eligible veterans, workers’ compensation after a work injury, and rebate programmes from vehicle manufacturers, which typically cover up to about one thousand dollars of adaptive equipment on a new vehicle. Medicare does not pay for vehicle modifications.
Licensing rules differ by state. Most require a medical report and a road test with the adapted vehicle before the licence is annotated with the equipment restriction.